Primary chemotherapy in breast cancer.

Primary (neoadjuvant) chemotherapy is a rapidly evolving area in the management of early operable breast cancer. This approach achieves significant responses in around 80% of patients, with a reduction in the need for immediate mastectomy in patients presenting with large primaries, with no evidence of increased local recurrence. So far randomised trials suggest that survival is as good with primary chemotherapy as with post-operative adjuvant chemotherapy. Primary chemotherapy offers the potential short term tumour response as a predictor for longer term survival. More importantly, it allows serial biological measurements of treated breast cancers which, in turn, may aid the selection of appropriate treatment for individual patients and allow the rapid assessment of new therapies.